1st

First Trimester

How exciting – you’re having a baby! The first trimester is a time to plan ahead for the changes on the way.

READ MORE
2nd

Second Trimester

You’re into the pregnancy groove now…see why some women say the 2nd trimester is the most enjoyable.

READ MORE
3rd

Third Trimester

You’re on the final stretch! Here’s what you can expect as you get closer to having your baby.

READ MORE

When to Call your Doctor

Most pregnancies are normal and uncomplicated. However, sometime you may experience symptoms that seem abnormal

READ MORE

1st Trimester


How exciting – you’re having a baby! The first trimester is a time to plan ahead for the changes on the way.

First Trimester

Your chosen health care provider will begin providing education and care management for you as you go through pregnancy from your first visit throughout the birth of your new baby. He or she will be with you each step of the way, providing support, guidance, and treatment throughout your pregnancy and will be there to deliver your new little miracle.

In your first visit, your provider will review and assess your overall health status, discuss identified risk factors for your pregnancy, and determine your baby’s gestational age. In order to do this, your provider will ask direct and detailed questions regarding your past and current health practices. Remember, honesty is vital, as your answers help determine the plan of care for you and your baby. If you have concerns or feelings of discomfort at having such conversations in the presence of your partner, request a private appointment at a later time.

You provider may offer first trimester genetic screening at the initial visit. Please ask any clarifying questions regarding these tests at that time. Once you have completed your initial visit, follow-up visits typically occur every 4 weeks until you reach 28 weeks of pregnancy. Be prepared at these visits to discuss any questions or concerns you have about your pregnancy. This is your dedicated time with your provider. Remember, the only foolish question is the one not asked.

1st Trimester 1 through 12 weeks

What you can expect during your first trimester (3 months) of pregnancy


Morning Sickness

While labeled “morning sickness,” nausea can occur at any time day or night during the first trimester of pregnancy. The rapidly increasing hormones of pregnancy are associated triggers for early pregnancy nausea attacks. Pregnant women may also experience a heightened sense of smell. Therefore, certain strong odors such as may initiate bouts of nausea during early pregnancy as well.

One tip to help manage the nausea of early pregnancy is to have small snack-sized meals throughout the day. Focus on foods that are fresh, baked, grilled, boiled or broiled while avoiding fatty or greasy products. It is also important to drink plenty of liquids such as water, Sprite, or ginger ale. Avoid caffeinated beverages when possible.

If you are having difficulty passing urine or your urine is dark-colored, you should contact your care provider. Also, contact your provider if you are unable to hold down any food or fluids, feel dizzy upon standing, feel as if your heart is racing, or are vomiting blood.

Breast Changes

The hormones of pregnancy affect your breasts, too. Early in pregnancy your breasts may become sore, tender, or experience tingling sensations. They may also appear more full and heavy. One measure to help alleviate these discomforts is to wear a good, supportive brassiere or sports bra.

Increased Urination

As your uterus enlarges with your growing baby, the added weight puts extra pressure on your bladder. This extra pressure will cause you to have more frequent trips to the bathroom. If you find yourself losing sleep or having poor-quality sleep due to frequent night-time bathroom visits, limit the amount of fluid intake in the evening hours. If you have concerns about leaking urine, you can consider wearing a panty liner for bladder security. It is important that you go to the bathroom whenever you feel the urge to urinate as this will help reduce risks of urinary tract infections.

Fatigue

Being tired is a common feeling during the first trimester. The increasing level of the pregnancy hormone progesterone causes you to sleep more, while dips in your blood sugar and blood pressure may cause a drop in energy levels. Be sure you are getting adequate rest and sleep at night. It is also important to take in the recommended levels of protein and iron rich foods which are needed to help your baby grow. Exercising for at least 30 minutes a day on most, if not all, days of the week has also been proven to increase energy levels and has been recommended as a best health practice by the American College of Obstetrics and Gynecology.

Dizziness

Dizziness in pregnancy can be associated with low blood sugar, a decrease in blood pressure, fatigue, or stress. The pregnancy hormones cause your blood vessels to relax and dilate, which can lead to a drop in blood pressure when rising quickly as well. To minimize dizzy events, eat well, stay hydrated, get plenty of rest, and stand up slowly and deliberately after sitting or lying down. If you begin to experience a dizzy spell, stop what you are doing and sit or lie down.

Heartburn and Constipation

Throughout your pregnancy, digestion and the movement of foods through your stomach and intestines slows down. This slowdown is important as it provides extra time for your body to absorb as many nutrients as possible to help your baby grow and develop. However, this slow passage can lead to bouts of heartburn or constipation. Eating small, frequent, low-fat meals can help prevent heartburn. Avoid spicy, carbonated, acidic, fried, and caffeinated foods and beverages as well. Increasing fresh fruits and vegetables or adding fiber supplements to your diet will help minimize constipation.

Emotions

Pregnancy hormones can trigger a myriad of emotions. You can feel ecstatic, scared, stressed, overwhelmed, and exhausted. And you may feel all of this at the same time! It is important to know that even though you are overjoyed with your new pregnancy, the new baby brings added emotional stress to you as well. It is completely normal to have thoughts about finances, your ability to be a good parent, how your baby is growing and will he/she be okay, and how this new addition will affect the relationship with your spouse. You might worry about how you will be able to continue work, either in or outside of the home, while you are pregnant and after your baby comes. It is not uncommon to experience mood swings, crying spells, or reservations about the decisions you are making. Remember, all of this is normal. Continue to take care of yourself, and your growing baby. Look to your partner, family and friends for emotional support, care, and encouragement. If the mood swings progress, or you have thoughts of hurting yourself or others, consult your healthcare provider immediately.

You and Your Partner

Giving the time, care and attention to your new baby may make you think other relationships in your life are suffering. You are proud and overjoyed at being a new mom, but how do you keep the relationship with your partner going strong as well? Communication is a vital tool at this point in your life and relationship.

  • Honesty. Talk to your partner about the need you have for both emotional and physical support and tenderness. Identify stressors in the relationship and address them before problems arise from them. Remember, intimacy does not always have to be sexual in context and it is important to discuss your feelings openly and honestly with your partner.
  • Patience. If conflict or misunderstanding occurs, take a moment to consider both sides of the issue. You may see your partner’s increased time or attention to work details as a withdrawal from you and your new baby, while your partner may simply be concerned over abilities to provide a secure financial future for the new family.
  • Support. Foster the development of open communication by encouraging your partner to speak openly and freely about concerns, fears, or issues they may have in their new role. Open, honest communications will serve to strengthen the relationship you have with your partner, and help ease the transitions as you prepare to become a new mother.

2nd Trimester


You’re into the pregnancy groove now…see why some women say the 2nd trimester is the most enjoyable.

Second Trimester Many women consider the second trimester of pregnancy the most enjoyable. Morning sickness has usually subsided by now. Your growing baby isn’t yet large enough to exert large amounts of pressure on your bladder or on the organs and structures within the abdominal cavity. However, there are changes that you should be aware of and expect as you progress through this stage of your pregnancy.









2nd Trimester 13 through 27 weeks

What you can expect during your second trimester (3 months to 6 months) of pregnancy


Breasts

The hormones of pregnancy stimulate the milk-producing glands, causing an increase in breast size. You may also have the accumulation of additional fat stores within the breast. While the initial breast tenderness you experienced in the first trimester should improve, you may continue to experience nipple tenderness through the entire pregnancy. Therefore, it is very important to wear a good, supportive brassiere.

Your abdomen

As your baby grows and the uterus enlarges, you will notice your abdomen expanding. This happens quickly in some women, and more slowly in others. Anticipated weight gain during the second and third trimesters is three to four pounds each month.

Braxton Hicks contractions

You may begin to experience “warm-up” contractions as your uterus prepares for the big job it has coming in a few months. These “warm-up” contractions are referred to as Braxton Hicks contractions. You will feel these contractions in the lower abdominal and groin areas. Typically, these contractions are mild and have no set pattern. Should you experience contractions that are, or become, strong and regular, notify your provider immediately to discuss the risk of preterm labor.

Skin

You may notice skin darkening on your face. This is referred to as melasma, or the “mask of pregnancy”. Be advised that long-term sun exposure may cause the discoloration to darken even further. You may also experience skin darkening on your breasts as your pigment in the areola increases. Many women will also develop a dark line that extends down the center of their abdomen. This line may vary in darkness and is referred to as the linea negra or “dark line” of pregnancy. Another skin change you may experience is striae, commonly referred to as “stretch marks.”

The marks will be linear and varied in length. They may appear as purple, pink, or red lines on your thighs, legs, breasts, abdomen, arms, or buttocks. As the skin stretches, it may itch, so lotions can be helpful. While there is no way to prevent stretch marks from occurring, remember that over time, they will typically fade to a faint, silvery line.

Mouth and Nose

Pregnancy causes an increase in the blood and fluid circulating through your body. As more blood flows to the tissues of your body, moist mucous membranes can become swollen. For instance, the lining in your nasal passages become swollen and congested, which triggers stuffiness, snoring, or bloody noses. As your gums become more congested with blood, you may experience bleeding when you brush your teeth. Changing toothbrushes to one with soft bristles may help minimize bleeding gums. It is very important to remember proper dental hygiene and dental check-ups during your pregnancy.

Dizziness

You may continue to experience dizziness, as in the first trimester. Remember to drink plenty of fluids, change positions slowly, and if you experience dizziness, you should stop your current activity and sit until the dizziness passes.

Leg cramps

It is not uncommon to experience cramping in the lower legs during pregnancy, especially at night. Maintaining hydration is very important. It is also beneficial to stay physically active during pregnancy to help minimize muscle cramping. Since leg cramps do occur often at night, it may be helpful to perform calf stretches prior to going to bed. If you do experience a leg cramp, stretch the affected calf muscle. Do NOT massage the calf muscle or leg with cramps, just stretch the muscle. You may also consider a warm shower/bath or ice to the affected area.

Breathing

The increased need for oxygen to your growing baby and placenta triggers your lungs to process more oxygen than you normally would if you weren’t pregnant. The increased lung activity may cause you to breathe a little faster than your norm and leave you feeling a little breathless.

Vaginal Discharge

As your pregnancy advances, you may begin to experience an increase in the amount of vaginal discharge you have. The discharge should be thin and white in appearance. Should you notice any change in the discharge, such as coloration of yellow or green, a foul smell, or accompanying burning/itching, consult your provider right away as these could be signs of a vaginal infection. For comfort, consider wearing a thin panty shield in your underwear.

Urinary Infections

As your uterus expands from your growing baby, it may interfere with the flow of urine from the kidneys to the bladder, and from the bladder out. Pregnancy hormones will also slow down the flow of urine in the urinary tract. These factors increase your chance of developing either a kidney or a bladder infection-or even both. If you should experience a burning sensation with urinating, have a fever, notice a strong odor/discoloration to the urine, and have abdominal or back pain, notify your provider immediately to be evaluated for a urinary infection. If untreated, bladder or kidney infections can increase your risk of complications in pregnancy.

Emotions

Second trimester emotions are fun! You have a renewed sense of energy and well-being and are enjoying the pregnancy. Take advantage of this renewed vigor and attend prenatal classes on childbirth preparation and breastfeeding education. If you wish to continue employment outside of the home after you have your baby, it is important to know and understand your employer’s leave of absence policy for maternity events. Start looking into child care options now, as many area daycare facilities have waiting lists for enrollment.

As your body changes with the growing pregnancy, you may experience different emotional responses. Some women have a heightened sense of sexuality while others think their burgeoning bodies make them unattractive to others. If you are experiencing these concerns, remember to talk openly and honestly with your partner. Love and intimacy can be expressed in many different ways. Together, find ways that meet both your needs best. In anticipation of the big day, you may start to fret and worry over what to do and when to do it. Remember, all of the planning in the world cannot dictate just how your pregnancy and delivery will develop. The best you can do is to be prepared, attend classes, take good care of yourself, and make choices that are best for you and your baby.

Appointments

During your second trimester visits, your provider will measure your baby’s growth and discuss any health concerns or pregnancy risks you may have. Your weight, blood pressure, and urine will be checked at every visit. It is not necessary for your provider to perform pelvic exams during these visits unless you are experiencing problems. Your provider will also listen to your baby’s heartbeat with a hand-held device at each visit, and you get to hear the heartbeat each time! You may also have an ultrasound and other screening tests performed in the second trimester. If you wish to know, and the baby cooperates, you may even get to find out your baby’s gender. As mentioned in the first trimester, use these visits to discuss any questions or concerns you may have about your pregnancy, your baby, and yourself.

3rd Trimester


You’re on the final stretch! Here’s what you can expect as you get closer to having your baby.

Third Trimester With the continued growth of your baby, you will notice his or her movements much more easily and frequently. While it is exciting to know your baby is doing well, the movements may also trigger discomforts associated with strong kicks and turns.










3rd Trimester 28 through birth

What you can expect during your third trimester (6 months to birth) of pregnancy


Breasts

Once you reach the third trimester, you may have added up to two pounds of breast tissue. The closer you get to your due date, you may notice leaking of fluid from your nipples. This is the colostrum or “yellow gold” that you release in the first few days after delivery that will feed and protect your newborn in their first few days of life.

Weight

Typical weight gain in pregnancy is 25-35 pounds, depending on your starting body weight and size. While your baby accounts for a portion of that, the remainder is due to the placenta, amniotic fluid, increases in circulating blood and fluids, fat stores, breasts, and the uterus itself.

Contractions

Braxton-Hicks or “false labor” contractions are your body’s way of practicing for the real thing. These contractions are typically irregular in timing, and of weaker intensity than true labor contractions. A way to determine if the contractions are true labor or “false labor” is to assess the timing, strength, and duration of the contractions. If they become stronger, longer, and regular, consult your care provider.

Backaches

The pregnancy hormones that trigger the relaxation in your pelvis joints can also trigger back discomfort due to posture and gait changes. Be sure that you maintain good posture when standing and sitting. Use a lumbar support for the lower back when sitting. Wear a low-heeled, supportive shoe, and sit with your feet propped on a low bench. Your partner can help by providing massage, and gentle heat applied to the back may be helpful. If you have increasing or persistent back pains, notify your healthcare provider.

Breathing

As your baby grows, he/she shifts your diaphragm up, decreasing the room your lungs use when taking in a breath. This makes you feel as if you aren’t breathing enough, so you tend to breathe more quickly. Many women notice the ability to breathe deeper and more easily as the baby “drops” into the pelvis in preparation for delivery. Until that time, utilize good, upright posture and consider sleeping on extra pillows to maximize breathing at night and during rest.

Heartburn

Heartburn or indigestion continues to occur as your baby’s growth puts pressure on, and moves your stomach out of its normal place. To minimize symptoms, sit upright after meals, avoid nighttime snacking, eat smaller portions per meal and consume plenty of fluids. Stay away from fried, fatty, spicy, acidic, or carbonated foods, and limit caffeine intake. You can speak with your provider regarding recommendations for antacids if needed.

Swelling

You may notice that your feet, ankles, and legs start to swell during the day as you are up and out. This is related to the increased pressure your growing uterus is putting on venous circulation to your lower body. In addition, you may notice numbness or tingling in your hands, fingers, and arms as the swelling in your upper extremities puts pressure on underlying nerves. The added fluid lends itself to facial swelling, especially in the mornings after you have been lying flat for an extended period of time. If you notice persistent facial swelling, especially in the eyelids or around the eyes, notify your care provider. Measures to help reduce swelling include using a foot stool to prop up your legs when sitting, sleeping propped up on pillows, and using pillows to slightly elevate and support your arms while resting.

Hemorrhoids & Varicose Veins

You may notice prominent or swollen bluish-purple colored veins running just under the skin. These are known as “varicose veins.” While varicose veins are more common in the legs, they may also occur in the genital area, or as “hemorrhoids” in the rectal area. An intervention to consider with varicosities in the lower extremities is to keep legs elevated when sitting and to wear maternity support hose. With hemorrhoids, it is better to practice prevention. Be sure to drink ample amounts - at least 64 ounces - of water each day, and increase your daily intake of fiber through fresh fruits and vegetables. Avoid becoming constipated and straining with bowel movements.

Urinary Frequency

The more your baby grows, the heavier he/she gets. The added weight begins to put an almost constant pressure on your bladder, making you feel as if you need to urinate more often. The added pressure may also cause you to experience slight leaking of urine when you cough or sneeze. Utilizing a panty liner will help provide comfort and security against urine leakage. Continue to observe for signs and symptoms of urinary infections such as burning with urination, discoloration to urine, a foul odor to the urine, fever, or backache.

Vaginal Discharge

Vaginal discharge tends to increase during the last weeks of pregnancy. Discharge is typically white and non-odorous. If you feel you have an unusually large amount of discharge, soak a panty liner, or if the color/odor of the discharge changes, notify your care provider.

Emotions

With anticipation comes fear. You are excited about the pending birth, however there are fears such as “Am I ready? or “Can I do this?” As mentioned before, attending a childbirth preparation class may help alleviate some of your concerns. You will be able to talk with others who are having the same thoughts, fears, and concerns as you! Remember, you may have a plan in birth plan in mind, but your baby often will call the shots. Keep your mind open and outlook positive!

One way to work through your feelings and even doubts is to journal your thoughts or fears. Remember your baby can hear and recognize your voice, so talk to him or her. Capturing your pregnancy through pictures is a way to go back and share the experience with your son or daughter down the road. Start planning for the future. If you plan to breastfeed your baby, start gathering the tools and equipment you may need to help you, such as a nursing pillow, nursing bras and tops, and a breast pump and pump supplies. Visit a Lactation Consultant or take a breastfeeding class. Join a breastfeeding support group in order to discuss thoughts, fears, and successes with your peers. If possible, visit area pediatricians to try and determine who will be providing care to your new arrival. And go ahead and plan a schedule for your first weeks at home, providing structure to friends and family who want to visit but may not know when the best times for you would be.

Your Office Visits

In the last trimester, your visits occur more frequently. Your visits will increase to every two weeks at 30-32 weeks, and every week from 36 weeks until delivery. You will continue to have blood pressure, weight, and urine checks at each visit. Tests you can expect are the glucose screening (if not previously done), a hemoglobin level to check for anemia, and a culture to check for Group B Strep.

Group B strep (GBS) is different from what you may recognize as strep. GBS does not live in the throat, but in the vaginal or rectal area. While GBS shouldn’t make you sick, if your newborn comes into contact with the bacteria, and has not received protection, he or she may develop an infection after delivery. If you test positive for GBS in pregnancy, your provider will discuss care and interventions, likely to include antibiotic treatment during your labor.

In the last few weeks of your pregnancy, your provider may begin to perform vaginal exams to determine if the cervix is showing any changes in preparation for delivery. It is important to remember that cervical change is not a predictor of when labor will begin.

It will be important to review any specific requests or plans for labor with your provider prior to the big event. This will allow for an open discussion to ensure full understanding and expectations. Remember, these visits are your time to ask questions of your provider. The only foolish question is the one never asked.

When to Call your Doctor


Most pregnancies are normal and uncomplicated. However, sometimes you may experience symptoms that seem abnormal. Check out this information about signs that you need to call your doctor.

Your body experiences many changes during pregnancy. Some of these are normal, even if they are uncomfortable. However, if you experience any of the warning signs listed below or have other symptoms you feel aren't normal, call your doctor immediately.

Preterm labor (three weeks or more before your due date)


  • Contractions - more than four in an hour
  • Menstrual-like cramps - may come and go or be constant
  • Abdominal cramps - may occur with or without diarrhea
  • Pelvic pressure - feels like the baby is pushing down
  • Change in vaginal discharge - a sudden increase in the amount, or it may become more mucus-like, watery or tinged with blood
  • Low backache - comes and goes or may be constant

Vaginal bleeding


Bright red vaginal bleeding isn't normal. Call your doctor, and be sure to communicate the amount of bleeding and whether clots are present.

Abdominal pain


  • Severe nausea and vomiting
  • Severe abdominal pain, especially if you are also experiencing bleeding, nausea or vomiting

Swelling


  • Sudden and severe swelling of hands, face or eyes, especially if accompanied by headache or blurred vision
  • Sudden weight gain of more than two pounds accompanied by swelling of hands and face

Decreased Fetal Movement


You may choose to use a fetal activity chart during the last weeks of pregnancy to track movement. Seek medical attention if you notice the following:

  • Absence of movement for 24 hours after the sixth month
  • Significant lessening of movement

Fever


  • A fever of more than 100.4° F can be dangerous. Call your doctor immediately

Headache


  • Severe headache
  • Seeing spots or flashing lights
  • Other neurological symptoms, including:
    • Numbness
    • Loss of vision
    • Weakness
    • peech difficulty
    • Fainting or dizziness

Urinary discomfort


  • Frequent urination with small amounts of urine
  • Painful urination, especially when accompanied by fever, chills and backache
  • Blood-tinged urine
  • A sudden increase in thirst, accompanied with no desire to empty your bladder

What medications can I take?


What medications are safe to take during pregnancy? See the information below, and call your doctor if you have further questions about medications.

During pregnancy, it is important to remember that most medications easily pass from the mother’s bloodstream into the baby’s bloodstream. While some medications are much safer than others during pregnancy, all medications, including those you can buy without a prescription, have the ability to affect your developing baby. For this reason, pregnant women should try to manage common discomforts of pregnancy without taking any medication when possible. Avoid medications in the first 12 weeks whenever possible. If you have discomforts that require medication, the information in the table below has been developed to guide you in selecting the safest choices. Please contact your doctor’s office if you have any questions regarding the safety of medications during pregnancy.

Indigestion Mylanta (aluminum hydroxide + magnesium hydroxide + simethicone)
Rolaids (calcium carbonate + magnesium hydroxide)
Maalox (aluminum hydroxide + magnesium hydroxide)
Tums (calcium carbonate)
Pepcid AC (famotidine)
Zantac (ranitidine)
Nausea Emetrol (phosphorated carbohydrates)
Ginger tea or capsules
Sea Bands (acupressure – ask pharmacist)
Constipation FiberCon (polycarbophil)

Metamucil (psyllium) Milk of Magnesia (magnesium hydroxide)
*Stop vitamins for 4 days, then restart every other day
*Notify your nurse
Hemorrhoids Preparation H, Tucks (witch hazel), baby wipes (use instead of toilet paper), Anusol anti-inflammatory hemorrhoid cream
Vaseline
Epsom salt tub bath (use 1-2 cups in warm tub; soak 20-30 minutes)
Stool softener Surfak (docusate calcium)
Colace (docusate sodium)
Metamucil (psyllium)
Citrucel (methylcellulose)
Dulcolax (oral)
Miralax (polyethylene glycol 3350)
Diarrhea Immodium (loperamide)
Drink only liquids for 24 hours. If you have a fever, nausea/vomiting, call your doctor.
Yeast infection Baking soda bath, Mylanta compress (simethicone)

After first 14 weeks:
Monistat (miconazole)
Vagistat
Gynelotrimin (clotrimazole)
Ligament pain Tylenol (acetaminophen)
Warm bath or shower (not hot)
Heating pad to back only
Cold/flu Nasal congestion – Breathe Right strips, humidifier, saline nasal spray, Mucinex, Vicks VapoRub
Sore throat – Sucrets, Halls cough drops, warm salt water gargle

After first 14 weeks:
Nasal decongestant – Sudafed (pseudoephedrine)
Allergy symptoms/insomnia – Benadryl (diphenhydramine), Clortrimeton (chlorphenamine), Zyrtec (cetirizine)
Cough – Robitussin DM (guaifenesin, dextromethorphan)

Do you need more information?

We tried to include information about every facet of pregnancy and childbirth at EAMC on our web site, but if you still have questions, please feel free to contact us and we will respond within 48 hours.